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Foreword ix
Introduction xiii
Chapter 1. Comparison: The Key to Understanding Human Specificity 1
1.1. Comparison, a source of clarity 1
1.2. Different models of the foot and ankle throughout evolution 1
1.2.1. Evolution of the chiridial limb 2
1.2.2. The human model 6
1.2.3. Comparative functional anatomy 9
1.3. Different functional anatomy models of bipedalism, from turkeys to humans and great apes 10
1.3.1. Challenges in terms of phylogeny 10
1.3.2. Definition of bipedalism 11
1.3.3. Different bipeds 12
1.3.4. Conclusion 23
1.4. Permanent terrestrial human bipedalism, explained through the model of the bi-articular muscles 23
1.4.1. Introduction 23
1.4.2. Kinematic analysis 24
1.4.3. Dynamic analysis (Figure 1.22) 26
1.4.4. Electromyography 28
1.4.5. Surgical treatment 31
1.4.6. Conclusion 32
1.5. Alternating dorsal/plantar flexion of the ankle; comparison with the great ape 32
1.5.1. Kinematic analysis 33
1.5.2. Dynamic analysis 36
1.5.3. Conclusion 36
1.6. Dorsiflexion location (Figure 1.15) 37
Chapter 2. The Aim of Surgery: Restore Function 39
2.1. Introduction 39
2.1.1. The notion of sacrifice 39
2.1.2. Normal 39
2.1.3. Useful 40
2.1.4. Direct surgical implications 41
2.2. Hallux valgus 42
2.2.1. Pathophysiology 42
2.2.2. Normality/utility balance 45
2.3. Arthrodesis 48
2.3.1. The first cuneometatarsal joint (C1M1) 48
2.3.2. First metatarsophalangeal joint (MTP1) 52
2.4. Excessive mechanical pressure under the forefoot (second, third and fourth metatarsals - M2, M3 and M4, respectively) 55
2.4.1. Biomechanics and evolution 55
2.4.2. Pathophysiology 57
2.4.3. Surgical treatment 58
2.5. Plantar plate 60
2.5.1. Introduction 60
2.5.2. Plantar plate in primates 60
2.5.3. Anatomy 61
2.5.4. Biomechanics 64
2.5.5. Mechanical balance 66
2.5.6. Treatment 66
2.6. Release of gastrocnemius muscles 66
2.7. Claw toes (Figure 2.34) 67
2.7.1. Surgical alternatives 67
2.7.2. Anatomy reminder 69
2.7.3. Extension function 71
2.7.4. Flexor tendons: which priorities? 74
2.7.5. Unusual anastomose 78
2.7.6. Conclusion 79
2.8. Second ray syndrome 80
2.8.1. Medical and surgical considerations 80
2.8.2. Second metatarsal in human primates, non-human primates and fossil hominids 83
2.8.3. Treatment 94
2.8.4. Conclusion 95
2.9. Morton's neuroma 95
2.9.1. Introduction 95
2.9.2. Pathological anatomy review 95
2.9.3. Clinical consequence 97
2.9.4. Surgical options 97
2.9.5. Choosing between utility and normality 98
2.10. Appendix: anatomy and function of tendons 98
Chapter 3. Rapid Healing Through Immediate Use of the Operated Foot: A Purpose 101
3.1. Introduction 101
3.2. The need for a concept 102
3.3. New percutaneous and minimally invasive techniques 102
3.3.1. Development of percutaneous surgery 102
3.3.2. Principles of percutaneous surgery 103
3.3.3. Biomechanical translation of this new conceptual approach 105
3.3.4. Absence of pain 109
3.3.5. Immediate full weight bearing 110
3.3.6. Manipulations 111
3.3.7. Technological innovation 111
3.3.8. New role for postoperative dressings 112
3.3.9. Outpatient surgery 112
3.3.10. New work in anatomy 114
3.3.11. Conclusion 114
3.4. Biomechanics of stability 114
3.5. Pain and recovery 118
3.6. Forces and tissue growth 118
3.6.1. Introduction 119
3.6.2. Applicable forces 121
3.6.3. Mechanoreceptors - the starting point 130
3.6.4. Intracellular transmission: cytoskeleton and extracellular matrix 133
3.6.5. Intracellular biochemical reactions 137
3.6.6. Translation by physical elements 138
3.7. Conclusion 154
Conclusion 155
References 157
Index 177
It is difficult to understand the specificity of an object or a function, if we do not compare it with a model that resembles it. Highlighting differences will allow us to grasp their distinctiveness. The smaller the difference, the more difficult it is to detect if it is isolated from a similar environment, but the more it characterizes the specificity of the object being studied.
This easy-to-understand approach when comparing color, from blue to green via emerald, for example, is more complex when it comes to functional anatomy models. Our understanding of specificity cannot be dissociated from the effort of classification and the establishment of phylogeny.
Indeed, by carefully establishing derived and ancestral characteristics, it is possible to establish differences and then classify according to the principle of parsimony. According to Aristotle, let us "search for relations between apparently independent things and search for similarities between things that are dissimilar in the eyes of the common man". Knowing things makes it possible to see them acutely; verbalizing them makes it possible to think about them.
Locomotion involves a variety of movements adapted to different environments and lifestyles.
Identical morphological organization and processes common to all vertebrates are implemented, but thanks to original anatomical elements, animals can move with highly sophisticated means and respond, each in their own way, to the constraints of their environment.
Among the many elements involved in the musculoskeletal system's function, the foot and ankle (crurotarsal or talocrural joint) were chosen because they undergo the most spectacular and elaborate transformations during adaptation to different types of locomotion: running, trotting, tree climbing, etc. Mammals have anatomical adaptations that reflect their specific mode of locomotion.
The chiridial limb represents the general limb structure of tetrapods. There are significant differences between mammalian classes, but the general pattern is identical, as shown in Figure 1.1.
The foot represents the autopod (Figure 1.1); succeeding the leg sector which constitutes the zeugopod. The autopod consists of three parts: the tarsus (basipod), the metatarsus (metapod) and the phalanxes (acropod).
Figure 1.1. The chiridial limb: general structure of a tetrapod's limb. For a color version of the figure, see www.iste.co.uk/cazeau/foot.zip
The typical shape is pentadactyl and almost always has a locomotor function.
When our gait is increased or semi-increased, the foot is plantigrade, with five complete segments numbered from 1 to 5, from the tibial (medial) side to the fibular (lateral) side. In quadrupedal gait, the hands and feet have similar functions. The number of segments is reduced, four in the digitigrade of carnivores and even less in unguligrades.
Let us quickly put the tarsus and the zeugo-autopodal joint into context.
The appearance of the chiridial limb in the Late Devonian period (370 million years ago) was a fundamental acquisition that enabled the transition from aquatic to terrestrial life. Anatomically speaking, it was the transition from an aquatic fin to a limb that enabled the conquest of continents. Seventy million years after its alleged disappearance, the famous missing link, the coelacanth fish, was caught in 1938 in the Comoros. Its fin seemed to have the anatomical shape of a section with the chiridial limb.
The structure is as follows (Figure 1.1): the proximal segment or stylopod is represented by the arm (humerus) or thigh (femur), the middle segment or zeugopod is the forearm (radius and ulna) or leg (tibia and fibula) and the distal segment or autopod, consisting of three parts, is the hand or foot. The basipod corresponds to the tarsus (and the carpus), the metapod to the metatarsus (metacarpus) and the acropod to the phalanxes.
Here, we are interested in the ankle (zeugo-autopodial joint). This limb has maintained its general structure but has evolved differently according to lineages.
The ancestors of the first amphibians (labyrinthodontia) were known since the Devonian period. They had an autopod made of multiple parts whose main center of mobility was the joint spaces between the basipod and the metapod (Chopart).
During evolution, numerous fusions took place; a talus and a calcaneus were observed in the whole group at the origin of the mammals, turtles, reptiles and birds (amniotes).
Then, two main developments occurred; the first group came to be represented by turtles (chelonians), most reptiles and birds, and the second by mammals.
In the first, the talus-calcaneus pair is immobilized on the zeugopod, the fibula participates as much as the tibia in the function and the foot's movement is more distal in the tarsus (Figure 1.2).
Figure 1.2. Lower limb of a reptile (crocodile)
The gastrocnemius muscle remains inserted opposite the plantar fascia (Figure 1.3).
Figure 1.3. Insertion of gastrocnemius on plantar fascia below mediotarsal joint. For a color version of the figure, see www.iste.co.uk/cazeau/foot.zip
aIn mammals, the functional joint is located between the zeugopod and the basipod. The talus is superimposed on the calcaneus which develops the sustentaculum tali, the fibula participates much less in the joint and regresses and the insertion of the gastrocnemius muscle is transferred to the calcaneal tuberosity, effectively increasing its strength (Figure 1.4).
Figure 1.4. Insertion of gastrocnemius on calcaneus. For a color version of the figure, see www.iste.co.uk/cazeau/foot.zip
Anatomical adaptations are then made according to the type of locomotion. These concern the entire limb, but the autopod undergoes the most significant transformations (Figure 1.5).
Figure 1.5. Transformation of lower limb and, in particular, the autopod to match the type of locomotion. For a color version of the figure, see www.iste.co.uk/cazeau/foot.zip
Adaptation to quadruped running was achieved through three types of simultaneous modifications: lengthening of the limbs (especially at the expense of the metapod), raising of the autopod and progressive reduction in the number of fingers. The same applies to the adaptations for jumping, tree climbing, flying or when returning to aquatic life.
Following this general description, we will focus on the human model from now on.
The transverse stabilizing factors of the ankle concern the bones and are related to the following:
Figure 1.6. Human crurotarsal joint (front view). 1) Lateral malleolus; 2) tibial articular surface of the talus. For a color version of the figure, see www.iste.co.uk/cazeau/foot.zip
Figure 1.7. Proximal side of a human crurotarsal joint (view from below). For a color version of the figure, see www.iste.co.uk/cazeau/foot.zip
The amplitude of flexion/extension primarily depends on the extent of the proximal articular surface of the talus and the tibial surface. Other factors are bone abutments, ligament tension and, to a lesser...
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